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Journal article
Association of Early Hemodynamic Profile and the Development of Systolic Dysfunction Following Traumatic Brain Injury
Neurocritical care, v 26(3), pp 379-387
01 Jun 2017
PMID: 28000133
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
While systolic dysfunction has been observed following traumatic brain injury (TBI), the relationship between early hemodynamics and the development of systolic dysfunction has not been investigated. Our study aimed to determine the early hemodynamic profile that is associated with the development of systolic dysfunction after TBI.
We conducted a prospective cohort study among patients under 65 years old without cardiac comorbidities who sustained moderate-severe TBI. Transthoracic echocardiography was performed within the first day after TBI to assess for systolic dysfunction. Hourly systolic blood pressure (SBP), mean arterial pressure (MAP), heart rate, and confounding clinical variables (sedatives, fluid balance, vasopressors, and osmotherapy) were collected during the first 24 h following admission. Multivariable linear mixed models assessed the early hemodynamic profile in patients who developed systolic dysfunction, compared to patients who did not develop systolic dysfunction.
Thirty-two patients were included, and 7 (22 %) developed systolic dysfunction after TBI. Patients who developed systolic dysfunction experienced early elevation of SBP, MAP, and heart rate, compared to patients who did not develop systolic dysfunction (p < 0.01 for all comparisons). Patients who developed systolic dysfunction experienced a greater rate of decrease in SBP [-10.2 mmHg (95 % CI -16.1, -4.2)] and MAP [-9.1 mmHg (95 % CI -13.9, -4.3)] over the first day of hospitalization, compared to patients who did not develop systolic dysfunction (p < 0.01 for both comparisons). All sensitivity analyses revealed no substantial changes from the primary model.
Patients who develop systolic dysfunction following TBI have a distinctive hemodynamic profile, with early hypertension and tachycardia, followed by a decrease in blood pressure over the first day after TBI. This profile suggests an early maladaptive catecholamine-excess state as a potential underlying mechanism of TBI-induced systolic dysfunction.
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Details
- Title
- Association of Early Hemodynamic Profile and the Development of Systolic Dysfunction Following Traumatic Brain Injury
- Creators
- Vijay Krishnamoorthy - University of WashingtonAli Rowhani-Rahbar - University of WashingtonNophanan Chaikittisilpa - Harborview Injury Prevention and Research CenterEdward F Gibbons - University of WashingtonFrederick P Rivara - University of WashingtonNancy R Temkin - University of WashingtonAlex Quistberg - Harborview Injury Prevention and Research CenterMonica S Vavilala - University of Washington
- Publication Details
- Neurocritical care, v 26(3), pp 379-387
- Publisher
- Springer Nature
- Grant note
- L30 NS084420 / NINDS NIH HHS T32 GM086270 / NIGMS NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Urban Health Collaborative; Environmental and Occupational Health
- Web of Science ID
- WOS:000402101100009
- Scopus ID
- 2-s2.0-85006804690
- Other Identifier
- 991021966466104721
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Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Clinical Neurology
- Critical Care Medicine